@_ Employer's Data Record Reims 9dr Philippine Health Insurance Corporation Pe Reriohiastes oie Cysts Cente orang Crote, Fsg Cay 1400 319999 locate Phithealth Employer No.: 001020013114 Date Created/Edlted : 20-Dec-23 / 20-Dec-23 Employer Name COMPASIA COMPUTER REPAIR SERVICES INC, Encoder/Edltor 90660416 / 30660416 EMPLOYER INFORMATION Doc. Control No, TIN Number Address Email Address Telephone No. Main/Head Office Nature of Business Date Operation started Zip Code Employer Type Type of Business/Agency Head of Agency/Representative Title Position Status 1122023010002 186080564000 UG-15 CITYLAND WACK-WACK ROYAL MANSION, WACK-WACK GREENHILLS, MANDALUYONG CITY corporate.matters@lawphilh 286877900 COMPUTER REPAIR AND WHOLESALE AND RETAIL OF COMPUTER November 03, 2023 1501 Private Corporation SHENNAN A SY PRESIDENT OPERATIONAL DR. RAUL B. TUQUERO "Branch Menager NCR South Las Pitas Note: This is a system-generated form, signature is no! required.© Rptiic ofthe phitippiney a PHILIPPINE HEALTH INSURANCE CORPORATION iysate Cone, Barangay Oranbo, alg Cty 1600, 37-9989 Local 1116/1118, 1131 MEMBER DATA RECORD. PhilHealth Identification Number (PIN): 190899394635, Phils Number: : ‘Member Category + DIRECT CONTRIBUTOR - EMPLOYED PRIVATE NHTS Coverage 2 NIA Validity Period 2 NA SY, SHENNAN ARNAEZ UNIT 21£ 8 WACK WACK CONDO WACK WACK RD WACK-WACK GREENHILLS, MANDALUYONG CITY, SECOND DISTRICT- 1550 Foreign Address : NA Sex + MALE Date of Birth 03/26/1969 & Place of Birth BACOLOD CI, NEGROS OCCIDENTAL Contact No. (Foreign): NIA Civil Status = MARRIED. (loca) if ‘Tax Identification Number : 186080564 Philhealth Number (PENPOGN) 001020013114 Name of Employer/Organized Group : | COMPASIA COMPUTER REPAIR SERVICES INC. Business Address + UG-15 CITYLAND WACK: WACK ROYAL MANSION WACK: WACK GREENHILLS, MANDALUYONG CITY SECOND DISTRICT Telephone Number = 286877900 Employment Status : EMPLOYED ‘Tax Identification Number 1186080564000 Date 11/03/2023 (022543248588. SY SHAUN MATTIEU AU Male Son 11/29/2007, 022543248595 SY SHARLIZZE MAE AU Female Daughter 09/08/2070 “NOTHING FOLLOWS DR. RAUL B. TUQUERO Branch Manager NCR South Las Pifias Paalala : Basahin ang nillalaman ng MDR. Kung may kulang o mali ibalk agad upang maidagdag o maiwasto,Ingatan ang orhinal na kopya at huwagibigay kahitkanino, Kung sakaling gagamit at makikinabang ng benepisyo, magbigay ng kopya sa ospital, anid: Rud the cote ofthe MOR. Should hae be ay dita dicepaciey ret i back mend o rect the er, Tek ood cr ofthe MDR and donot hand cv o anybody ‘rove phetccopy te hosp in eas a onneer nd aalnet of beefs) This is a system generated report. Signature isnot required. Pinte At: SO PASIG-PASICOTY ria 926.1 omens MEOOR OmmaND BORNE aoe}Republic ofthe Philippines i 1 PHILIPPINE HEALTH INSURANCE CORPORATION | ‘Cyst Centr, Barangay ran, Pail 1600, as 637-5999 local 16,1116 1131 MEMBER DATA RECORD PhilHealth Identification Number (PIN) : 190899401968 PhilSys Number : ‘Member Category + DIRECT CONTRIBUTOR - EMPLOYED PRIVATE NHTS Coverage : NA Validity Period 2 NA LIGGAYU, OLIVER GERARD BALAO 2268 H3B P BURGOS STA CLARA BGY 4, PASAY CITY, FOURTH DIST. - 1300 Foreign Address 2 NA Sex MALE Date of Birth 7/09/1971 Place of Birth COTABATO CITY, MAGLINDANAO Contact No. (Foreign): NIA Ch Status MARRIED (Loca): 2185224/ Tax Identification Number + 189814823, Phithealth Number (PEN/POGN) 001020013114 Name of Employer/Organized Group; COMPASIA COMPUTER REPAIR SERVICES INC. Business Address :_UG-15 CITYLAND WACK-WACK ROYAL MANSION WACK.WACK GREENHILLS, MANDALUYONG CITY SECOND DISTRICT Telephone Number 286877900 Employment Status : EMPLOYED Tax identification Number "186080564000 Date + 11/03/2023 on2sist14857_UGCAYU ‘OLIVER NOAH FLORENDO Male Sen 1026/2008 n2709551106.LIGCAYU ‘OLVER NATHAN FLORENDO Male son sznaraor0 180515011971, UIGCAYU MARICRIS FLORENOO female Wife = suna7a NOTHING FOLLOWS DR, RAUL B. TUQUERO Branch Manager NCR South Las Piias Paalala ; Basahin ang rilalaman ng MDR. Kung may kulang o mali, ibalk agad upang maidagdag o maiwasto Ingatan ang orihinal na kopya at huwagibigay kahit kanino, Kung sakaling gagamit at makikinabang ng benepisyo, maghigay ng kopya sa osptal amine Ra che Gorter ofthe MOR. Should thee be ny dat cpr, run bck to aed ore the err Take goad ci ofthe MOR and dont hat vo ayo, Provide photccopyo hasta in eae af eon and avant cf beets) This is a system generated repor. Signature isnot required. Pint at: SOPASIC- PASE TY Yanan ses aanccors xc00eR testa) I Soe 1205003